Search PubMed⌕ Search

Biomedical subjects

P Blake

Publications and source records attributed to P Blake.

At least 73 records · Page 4Linked to original sources
PubMed1991

Septicemia in long-term jugular hemodialysis catheters; eradicating infection by changing the catheter over a guidewire.

By convention, septicemia occurring from an infected vascular catheter is treated with antibiotics and removal of the catheter. This approach, used with surgically implanted long-term catheters would be expected to result in loss of the vascular access site. During a 57 month period, we treated 21 episodes of septicemia secondary to infection of long term indwelling double lumen jugular venous catheters in our hemodialysis unit. Seventeen of 21 episodes were managed successfully by changing the catheter over a guidewire, thus preserving the access site. No relapse was observed after the antibiotic therapy was stopped. Only four patients required complete removal of the catheter and subsequent use of another site.

Actuarial Analysis↗
PubMed1990

A phase II study of ifosfamide and cisplatin chemotherapy for metastatic or relapsed carcinoma of the cervix.

A total of 44 women received a combination of ifosfamide (1.5 g/m2 daily x5) and cisplatin (50 mg/m2 on day 1 only) as first-line chemotherapy for recurrent or metastatic carcinoma of the cervix. In all, 12/42 (38%) evaluable patients responded, with the median duration of response being 7 months. Bone marrow and gastrointestinal toxicity were frequently severe. There were 3 septic deaths. Although cisplatin plus ifosfamide is an active combination against this disease, these results suggest that it is no more so than either drug used alone.

Adult↗
PubMed1990

Peritonitis-related deaths in continuous ambulatory peritoneal dialysis (CAPD) patients.

A total of 636 episodes of peritonitis occurred in 440 patients who entered our continuous ambulatory peritoneal dialysis (CAPD) program from September 1977 to February 1988. Sixteen patients (8 male and 8 female, aged 37-77 years) died during an episode of peritonitis (fatality rate 2.5%). They had been on CAPD for 3 to 105 (average 39) months. Six of them were diabetics. The peritonitis rate among these 16 patients were 1 episode per 12 patient months, while the corresponding figure for the whole (440) CAPD population was 14 patient months. Risk factors present in the 16 patients were: cardiovascular disease (12), cerebrovascular accident (2) peripheral artery disease (1) and pulmonary fibrosis (1). Fever and leukocytosis were present on admission in 11 patients, while total serum proteins and albumin were significantly lower (p less than 0.001) than the corresponding values before peritonitis (56 +/- 8 vs. 65 +/- 5). Staph. aureus was isolated in 8 patients (50%), multiple organisms in 6, Pseudomonas and Candida albicans in 1 each. An abdominal abscess was found in 4 (25%) patients. The peritoneal catheter was removed between the 5th and 10th day in 6 and after the 10th day in 7 patients. Peritonitis with sepsis was the cause of death in 13 patients. Contributing factors were cardiovascular accident in 9, uremic coma in 2, extensive GI bleeding in 2, GI perforation in 2, intestinal infarction in 1, and pneumonia in 2 patients. We conclude that the risk of peritonitis-related death in CAPD patients is increased with Staph. aureus or multibacterial peritonitis. Contributing factors are concomitant cardiovascular disease and delayed (greater than 5 days) catheter removal.

Cardiovascular Diseases↗
PubMed1990

Continuous veno-venous hemodialysis (CVVHD) in the management of complicated renal failure.

CVVHD is an effective treatment of choice applicable to all critically ill unstable patients with CARF. It is a technique that offers clinical advantages. It is easily initiated. It offers good clearance. Its closed dialysate circuit offers accurate control of UF that is adaptable to the patient's needs. The use of a blood pump reduces the risks of heparin-induced bleeding and arterial cannulation. In all patients, the blood flow rate was maintained at 100 ml/min. or more regardless of systemic BP. The UF removed per hour was between 100-200 mls/hour. Fluid removal on overloaded patients was easily accomplished with stable hemodynamic status. Adequate parenteral nutrition was able to be maintained to meet the requirement of the patients. The accuracy of the UF pump, no large volume fluid replacement and the safeguard of a closed system facilitates the work of the ICU nurses who have few or no adjustments to perform. Experience with CVVHD has proven that nurses working in the ICU are willing to be trained to take responsibility for this mode of treatment.

Hemofiltration↗
PubMed1989

A melatonin agonist and N-acetyl-N2-formyl-5-methoxykynurenamine accelerate the reentrainment of the melatonin rhythm following a phase advance of the light-dark cycle.

The rate of entrainment of the urinary 6-sulphatoxymelatonin rhythm to a phase-advanced photoperiod and the influence of a melatonin agonist and melatonin analogues and metabolites on the entrainment were investigated in male rats. Following an 8-h advance of a 14:10 light-dark photoperiod, the 6-sulphatoxymelatonin rhythm was disrupted completely for two days and became entrained after 5-6 days. Subcutaneous injection of the melatonin agonist, 6-chloromelatonin (0.5 mg/kg) and the brain metabolite, N-acetyl-N2-formyl-5-methoxykynurenamine (aFoMK, 10 mg/kg) two hours after dark onset on the day after the phase advance accelerated the entrainment to the new photoperiod. N-acetyl-5-methoxykynurenamine, 6-chloro-2,3-dihydromelatonin, 1,3-dihydro-5-(ethylacetamide)-7-methoxy-2H-1,4-benzodiazepin++ +-2-one and N-formylkynurenine were all without effect at a dose of 10 mg/kg. Treatment of rats with aFoMK on the day of the phase advance (day 0) together with treatment on day +1 accelerated the entrainment to the photoperiod whereas a single injection on day +2 or injections on day +1 and day +2 were without effect at a dose of 10 mg/kg. These results: (a) demonstrate the usefulness of monitoring urinary 6-sulphatoxymelatonin rhythms for pineal studies; (b) show that melatonin can indirectly influence its own secretion, presumably by interactions with the suprachiasmatic nucleus; and (c) provide further evidence for the biological activity of the brain metabolite of melatonin, N-acetyl-N2-formyl-5-methoxykynurenamine.

Animals↗
PubMed1989

Does autonomic neuropathy in diabetes cause hearing deficits?

This study examined the effect of autonomic neuropathy on hearing in diabetes mellitus. Twelve diabetics with autonomic neuropathy and eleven healthy controls were examined for hearing loss using standard audiological tests. Several subjects in both groups had some abnormal hearing tests, but the incidence was no greater in the diabetic group. No group trends were apparent. Diabetic autonomic neuropathy is unlikely to be associated with hearing deficits.

Acoustic Impedance Tests↗
PubMed1989

An overview of clinical trial experience with epanolol.

This overview of the safety and efficacy of the antianginal agent epanolol presents key features of the data from an international trial programme involving 1274 subjects. Additional information on the most frequently occurring possible adverse reactions is drawn from 2506 patients, which includes those in ongoing studies. Pooled analyses show that epanolol is as effective as reference therapies (nifedipine and atenolol), as assessed by work output during exercise tests, and in studies of anginal attack rate or work output during 12 months of treatment there was no evidence of tachyphylaxis with epanolol. Epanolol has a favourable safety profile, which compares well with those for placebo and for active antianginal therapies.

Adrenergic beta-Antagonists↗
PubMed1989

Splenic abscess and peritonitis in a continuous ambulatory peritoneal dialysis (CAPD) patient.

A 26-year-old female was on continuous ambulatory peritoneal dialysis (CAPD) because of diabetic end-stage renal failure. She developed an acute peritonitis that relapsed repeatedly despite appropriate antibiotic treatment. Investigations showed the presence of a splenic abscess, and splenectomy and peritoneal cannula removal were required. The patient died of myocardial infarction two weeks postoperatively. This is the first recorded case of peritonitis secondary to splenic abscess in a CAPD patient. Autopsy findings suggest that the abscess developed from infection of a splenic infarct.

Abscess↗
PubMed1989

The impact of ambulatory glycemic control on the insulin-dependent diabetic gravida.

The pursuit of maternal euglycemia is the cornerstone of contemporary perinatal management of the insulin-requiring diabetic gravida and its achievement has been associated with reduced perinatal morbidity and mortality. The maternal and perinatal results of a pregnancy management protocol for insulin-requiring diabetic gravidas which emphasizes rigorous glucose control via ambulatory patient utilization of reflectance meter determinations of fasting and two-hour postprandial blood glucose is summarized in this report. The authors describe the excellent maternal and neonatal outcomes achieved with this protocol, and emphasize the efficacy of this ambulatory approach to the treatment of insulin-dependent diabetic pregnancies.

Ambulatory Care↗
PubMed1989

Surgical treatment of skin cancer.

Eight hundred and twenty cases of skin cancer treated surgically at Saint Luke's Hospital over a ten-year period were reviewed retrospectively. Those undergoing excision, ie simple excision and primary closure, had significantly shorter hospitalization than those requiring grafts or amputation. The only prognostic factor in this particular series identified for local recurrence was a past history of skin carcinoma. Surgery was effective both as primary treatment and after failed irradiation. Local recurrence rates for skin carcinoma and melanoma were 8% and 10% respectively.

Basal Cell Carcinoma↗